Provider Demographics
NPI:1831471176
Name:BODY DYNAMICS
Entity Type:Organization
Organization Name:BODY DYNAMICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, RD
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:SUSANNE
Authorized Official - Last Name:SZEBNI
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LD/N
Authorized Official - Phone:305-924-7319
Mailing Address - Street 1:167 YACHT CLUB WAY
Mailing Address - Street 2:104
Mailing Address - City:HYPOLUXO
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6061
Mailing Address - Country:US
Mailing Address - Phone:305-924-7319
Mailing Address - Fax:
Practice Address - Street 1:167 YACHT CLUB WAY
Practice Address - Street 2:104
Practice Address - City:HYPOLUXO
Practice Address - State:FL
Practice Address - Zip Code:33462-6061
Practice Address - Country:US
Practice Address - Phone:305-924-7319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 5971133N00000X
FL1044812133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty